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A Guide For People With Medicare 



Choosing 



Long-Term Care 




Developed jointly by the 
Centers for Medicare & Medicaid Services 

and the 
Agency for Healthcare Research and Quality 



PUBS 

RA 

412 

.3 

C482 

2001 



SERVICE, 

Si 



Centers for Medicare & Medicaid Services 



-4^ 



This booklet, Choosing Long-Term Care, is 

one of a new series of booklets for people who 
are with Medicare. Other titles include 
Choosing a Doctor, Choosing Treatments, 
Choosing a Hospital, and Choosing a 
Medicare Health Plan. Each booklet can help 
you to make health care choices. Use this 
booklet to help you understand long-term care 
choices, who provides long-term care services, 
and how to pay for long-term care. 

To get a copy of this booklet in Braille or 
Spanish, call 1-800-633-4227, TTY/TDD: 
1-877-486-2048 for the hearing and speech 
impaired. 






i - 

4^.1 

JoO\ 



CONTENTS 

How This Booklet Can Help You 1 

A Few Words About Medicare 2 

Section 1: The Basics 5 

Words You Should Know 6 

Steps to Choosing Long-Term Care 8 

Things To Remember 21 

Section 2: If You Want To Know More 23 

More Words You Should Know 24 

Paying for Long-Term Care 25 

A Few Words About Nursing Homes 29 

A Few Words About Health Care Advance Directives 31 

Getting More Information 32 

This booklet has a lot of tips and questions to help you make the long- 
term care choice that is right for you. Some long-term care choices allow 
you to stay in your home, with the help of some services and programs 
available in your community. 

Get as much information as you can so you can make your best choice. 
But it is not necessary, or even possible, for every person to do everything 
this booklet suggests. Do as much as you feel comfortable with. 



._ 






A note about the symbols used in this booklet: 
C53 means a mailing address. 
^r means a telephone number. 



'M means a number for TTY or TDD, text telephones 
for people with hearing and speech impairments. 



□ 



means a computer Web site address. 



If you do not have a computer, your local library or senior 
center may be able to help you find information on their 
computers. 



How This 

Booklet Can 

Help You 

Long-term care is a "variety" of services that help people with health or 
personal needs and activities of daily living over a period of time. Long- 
term care can be provided at home, in the community, or in various types 
of facilities, including nursing homes and assisted living facilities. 

Choosing long-term care is a very important decision. Planning for 
long-term care requires you to think about possible future health care 
needs. It is very important to look at all of your choices; you will have 
more control over decisions and be able to stay independent. It is very 
important to think about long-term care before you may need care or 
before a crisis occurs. Even if you plan ahead, making long-term care 
decisions can be hard. 

To make the best choice, you need to think about: 

• What kind of care you need. 

• How your needs may change. 

• What long-term care choices you have. 

• How you will pay for your care. 

This booklet can help you make a long-term care choice that meets your 
needs and gives you good quality care. The basics you need to know are 
in the first section. The second section, which starts on page 23, has 
more information if you want to know more. 



A Few Words About Medicare 

If you have Medicare, you may be able to get your health care in more 
than one way. Medicare only covers medically necessary care under 
Part A (Hospital Insurance) and Part B (Medical Insurance). You must 
meet certain conditions for Medicare to cover skilled nursing facility, 
home health care, and hospice care. Generally, Medicare does NOT 
pay for long-term care. 

Original Medicare Plan (sometimes called fee-for-service) 

Everyone with Medicare can join the Original Medicare Plan. This plan 
is available nationwide. In the Original Medicare Plan you may go to 
any doctor or hospital that accepts Medicare. You pay your share, and 
Medicare pays its share. Some things are not covered, like most 
prescription drugs. 

You are in the Original Medicare Plan if you use your red, white, and 
blue Medicare Card when you get your health care. 

Medicare + Choice Plans (pronounced "Medicare Plus Choice") 

Medicare + Choice plans provide care under contract to Medicare. They 
may provide benefits like coordination of care or reduce out-of-pocket 
expenses. Some plans may offer additional benefits, such as 
prescription drugs. 

There are two types of Medicare + Choice plans: 

• Medicare managed care plans (like HMOs) 

• Medicare Private Fee-for- Service plans 




Medicare + Choice plans are available in many areas of the country. 
For information about the Medicare + Choice plans available in your 
area, look at www.medicare.gov on the Web, or call 1-800-MEDICARE 
(1-800-633-4227). 

Medicare pays a set amount of money for your care every month to 
these private health plans. In turn, the Medicare + Choice plan manages 
the Medicare coverage for its members. If Medicare + Choice plans are 
available in your area, you can join one and get your Medicare covered 
benefits. You must have both Medicare Part A and Part B to join a 
Medicare + Choice plan for the first time. However, if you are in a 
Medicare + Choice plan and only have Part B, you can stay in your 
plan. By joining a Medicare + Choice plan, you can often get extra 
benefits, like prescription drugs. The Medicare + Choice plan may have 
additional rules that you need to follow. You may also have to pay a 
monthly premium for the extra benefits. 

It is important to know how you get your Medicare health care. To 
learn more about Medicare, look at your copy of the Medicare & You 
handbook (CMS Pub. No. 10050) which is mailed each fall to people 
with Medicare. You can order one from the Medicare Web site or by 
calling 1-800-MEDICARE. 

ran www.medicare.gov 

?? 1-800-MEDICARE (1-800-633-4227) 
(24 hours a day, 7 days a week) 



m 1-877-486-2048 (toll-free) 

Other information about Medicare is also on the Medicare Web site. If 
you don't have a computer, your local library or senior center may be 
able to help you. 



NOTES 



4 




Section 1 



The Basics 




Words You 
Should Know 

Accessory dwelling unit (ADU). A separate housing arrangement within 
a single-family home. The ADU is a complete living unit and includes a 
private kitchen and bath. 

Activities of daily living (ADL). Activities you usually do during a 
normal day such as getting in and out of bed, dressing, bathing, eating, 
and using the bathroom. 

Assisted living. A type of living arrangement in which personal care 
services such as meals, housekeeping, transportation, and assistance with 
activities of daily living are available as needed to people who still live on 
their own in a residential facility. In most cases, the "assisted living" 
residents pay a regular monthly rent. Then, they typically pay additional 
fees for the services they get. 

Board and care home. A type of group living arrangement designed to 
meet the needs of people who cannot live on their own. These homes 
offer help with some personal care services. 

Continuing care retirement community (CCRC). A housing 
community that provides different levels of care based on what each 
resident needs over time. This is sometimes called "life care" and can 
range from independent living in an apartment to assisted living to full- 
time care in a nursing home. Residents move from one setting to another 
based on their needs but continue to live as part of the community. Care 
in CCRCs is usually expensive. Generally, CCRCs require a large 
payment before you move in and charge monthly fees. 

Custodial care. Nonskilled, personal care, such as help with activities of 
daily living like bathing, dressing, eating, getting in or out of a bed or 
chair, moving around, and using the bathroom. It may also include care 




that most people do themselves, like 
using eye drops. Medicare does not 
pay for custodial care. 

Health care provider. A person who 
is trained and licensed to give health 
care. Also, a place licensed to give 
health care. Doctors, nurses, 
hospitals, skilled nursing facilities, 
some assisted living facilities, and 
certain kinds of home health agencies 
are examples of health care providers. 



Long-term care. A "variety" of 
services that help people with health or personal needs and activities of 
daily living over a long period of time. Long-term care can be 
provided at home, in the community, or in various types of facilities, 
including nursing homes and assisted living facilities. Most long-term 
care is "custodial care." Medicare does not pay for this type of care. 

Long-Term Care Ombudsman. An advocate who works to resolve 
problems between residents and nursing homes, as well as assisted 
living facilities. 

Nursing home. A residence that provides a room, meals, and help with 
activities of daily living and recreation. Generally, nursing home 
residents have physical or mental problems that keep them from living 
on their own. They usually require daily assistance. 

Skilled care. A type of health care given when you need skilled 
nursing or rehabilitation staff to manage, observe, and evaluate your 
care. 



Subsidized senior housing. A type of program, available through the 
Federal Department of Housing and Urban Development and some 
States, to help people with low or moderate incomes pay for housing. 




Steps to Choosing 
Long-Term Care 

Long-term care is different from traditional medical 
care. Someone with a long physical illness, a disability, 
or a memory or thought problem (such as Alzheimer's 
disease) often needs long-term care. Long-term care is 
made up of many different services and may include 
help with activities of daily living like dressing, bathing, 
eating, and using the bathroom, as well as help with 
care most people do themselves like using eye drops. Long-term care can 
take place at home, in senior centers, at community centers, in special 
retirement or assisted living facilities, or in nursing homes. 

Generally, choosing the kind of long-term care you need is not an emergency. 
This means you have time to talk with your doctor about your health and any 
problems you may be having. It is also very important to talk with your 
family about the kind of long-term care services you think you might need 
someday, how much they would cost, and how you would pay for them. The 
best time to talk about long-term care is BEFORE you need services. 

Listed below are some steps that may help you choose the type of long- 
term care that meets your needs: 

Step 1. Think about the kinds of long-term care you may need. 
Step 2. Learn about the different types of long-term care choices. 
Step 3. Find out what choices are available where you live. 
Step 4. Find out how these programs and services rate in quality. 
Step 5. Visit the faculties or programs you are considering. 



Step 1. Think about the kinds of long-term care you may need. 

Some people think of long-term care services only as nursing home 
care. But there are many different kinds of long-term care. Long-term 
care can take place at home, in senior centers, at community centers, in 
assisted living facilities or special retirement communities, as well as in 
nursing homes. 

IMPORTANT: Medicare pays only for medically necessary skilled 
nursing facility or home health care. You must meet certain conditions 
for Medicare to pay for these types of care when you get out of the 
hospital. Most long-term care is considered custodial care. Medicare 
does not pay for custodial care. Custodial care is care that helps you 
with activities of daily living. It may also include care that most people 
do for themselves. 

The chart on the next page lists some of the many kinds of custodial 
care people often need, like help with activities of daily living or care 
most people do themselves. Think about whether you need these 
services now, or if you may need them in the future. Check off the 
services you think you may need. 

You may need help with only one or two types of activities of daily 
living, like help with eating or bathing. Or, you may need help with 
many activities of daily living or help with care needs, like diabetes 
monitoring or help with oxygen if you have breathing problems. Also, 
your needs may change over time. It is important to make a list of the 
kinds of services you need and revise this list as your needs change. 
The Summary of Long-Term Care Choices on page 1 6 may help you see 
which services or programs can help you with your needs. 



9 



Will I need help with the following activities of daily living? 

Eating 

Bathing 

Dressing 

Using the bathroom 

Other 



Will I need help with these additional services? 

Preparing meals 

Shopping 

Housework and laundry 

Getting to appointments 

Paying bills and other money matters 

Home maintenance and repair 

Other 



Will I need help with the following care? 

Remembering to take medicines 

Diabetes monitoring 

Using eye drops 

Getting oxygen 

Taking care of colostomy or bladder catheters 

Other 




10 



Step 2. Learn about the different types of long-term care choices. 

Many people think that long-term care takes place only in a nursing 
home. But there are many types of long-term care and living choices for 
older people. Some of the most common choices are listed here. See 
Section 2 for more about how to pay for long-term care costs. 

Community Services 

In many communities, there are services and programs to help people 
with their personal activities. Below is a listing of some home services 
and programs that are found in most communities: 

• Adult day care 

• Meal programs (like Meals-on- Wheels) 

• Senior centers 

• Friendly visitor programs 

• Help with shopping and transportation 

• Help with legal questions, bill paying, or other financial matters 

Some of these services are free. For example, some volunteer groups may 
provide help with housekeeping, paying bills, and help with shopping and 
transportation at no cost. Generally, senior centers do not cost anything. 
Other community services are available for a cost. Cost can vary 
depending on where you live and the type of service or program you 
need. To give you an idea of some costs for community services, in 2001, 
adult day care cost an average of $45 per day (8 hours). Home-delivered 
meals through the Meals-on- Wheels program cost an average of $52 per 
week for 10 meals (in 2001). The cost can be lower depending on your 
monthly income and expenses. 



11 



Home Care 

Depending on your needs, you may be able to get help with your 
personal activities (for example, help with the laundry, bathing, 
dressing, cooking, and cleaning) at home from family members, friends, 
or volunteers. If you think you need home care, talk to your family to see 
if they can help with care or help arrange for someone to come to your 
home to help. 

Some home care can only be given by licensed health workers, such as 
if you need skilled nursing care and certain other health care services 
that you get in your home for the treatment of an illness or injury. 
Skilled nursing care includes services and care that can only be 
performed safely and correctly by a licensed nurse (either a registered 
nurse or a licensed pratical nurse) or a licensed therapist. Remember, 
Medicare only pays for home care if you meet certain conditions. For 
more information, look at the Medicare booklet, Medicare and Home 
Health Care (CMS Pub. No. 10969). See pages 37-38 to find out how 
to get a copy. 

You can also hire a home health care agency for care in your home if 
Medicare doesn't cover it. In this case, you will need to pay for this care 
on your own. Home care costs can vary depending on where you live, 
the type of care you need, and how often you need care. Usually home 
care is charged by the hour. In 200 1 , the cost of nonmedical home care 
services ranged from $8 to $16 per hour. Skilled home care is much 
more expensive. 

Accessory Dwelling Units (ADUs) 

If you own a single-family home, and you don't want to move, and 
accessory dwelling unit may help you keep your independence. An ADU 
(sometimes called an "in-law apartment," an "accessory apartment," or a 
"second unit") is a second living space within your home or on your lot. 
It has a separate living and sleeping area, a place to cook, and a 
bathroom. Spaces such as an upstairs, basement, attic, or area over the 
garage can be turned into ADUs. 



12 



Creating an ADU at your home may bring you additional income, 
companionship, and help with house and yard maintenance. Having 
someone there to help with your personal needs, or getting your mail, or 
joining you for dinner can help you maintain your independence. 

Family members might be interested in living in an ADU in your home, 
or you may want to build a separate living space at your family 
member's home. Only you and your family can decide what choice is 
best for you. Either choice can help you maintain your independence. 

If you decide to create an ADU at your home, check with your local 
zoning office to be sure ADUs are allowed in your area. Most 
communities have rules regarding ADUs. 

The cost for an ADU can vary widely depending on how big it is, and 
how much it costs for building materials and workers. Some people do 
part of the construction work themselves to lower the cost. On average, 
the cost of an ADU can range from $10,000 to $60,000 (in 2001). 

Subsidized Senior Housing 

The Federal Government and most States have programs that help pay 
for housing for older people with low or moderate incomes. Usually 
you have to fill out an application, and there may be a waiting list. 
Some of these housing programs also offer help with meals and other 
activities like housekeeping, shopping, and doing the laundry. 
Residents usually live in their own apartments in the complex. 

Usually a Federal or State agency will review your monthly income and 
expenses to see if you are eligible for this type of housing. Rent 
payments are usually a percentage of your income. 

Board and Care Homes 

This group living arrangement provides help with activities of daily 
living such as eating, bathing, and using the bathroom for people who 



13 



cannot live on their own but do not need nursing home services. It is 
sometimes called a "group home." 

In some cases, private long-term care insurance and other types of 
assistance programs may help pay for this type of living arrangement. 
Many of these homes do not receive payment from Medicare or 
Medicaid and are not strictly monitored. The monthly charge is usually 
a percentage of your income. 

Assisted Living Facilities 

These facilities provide help with activities of daily living like bathing, 
dressing, using the bathroom, taking medicine, and getting to 
appointments as needed. Residents often live in their own room or 
apartment within a building or group of buildings and have some or all 
of their meals together. Social and recreational activities are usually 
provided. Some assisted living facilities have health services on site. 

Costs for assisted living facilities can vary widely depending on the size 
of the living areas, services provided, type of help needed, and where the 
building is located. Residents usually pay a monthly rent and then pay 
additional fees for the services that they get. In 2001, the typical cost of 
living in an assisted living facility ranged from $900 to $3,000 per 
month, but costs can be higher in urban areas or in upscale facilities. 

Continuing Care Retirement Communities (CCRCs) 

These housing communities have different levels of care based on your 
needs. Where you live depends on the level of care you need. In the 
same community, there may be individual homes or apartments for 
residents who still live on their own, an assisted living facility for 
people who need some help with daily care, and a nursing home for 
those who require higher levels of care. Residents move from one level 
of care to another based on their needs but still stay in the CCRC. 

If you are considering a CCRC, be sure to check the record of its 
nursing home. Your CCRC contract usually requires you to use the 



14 



CCRC nursing home if you need this level of care. Many of the 
questions that you might want to ask about these communities are the 
same as those to consider when choosing a nursing home (see page 29). 

CCRCs generally charge a large payment before you move in (called an 
entry fee) and then charge monthly fees. In 2001, the entry fee ranged 
from $60,000 to $400,000; sometimes these were refundable, and 
sometimes not. The monthly fee ranged from $700 to $2,500 (in 2001). 

You can also find out if a CCRC is accredited and get advice on 
selecting this type of long-term care community form the Continuing 
Care Accreditation Commission. 

en www.ccaconline.org 

^ 202-783-7286 

Nursing Homes 

These facilities provide care to people who cannot be cared for at home 
or in the community. Nursing homes provide a wide range of personal 
care and health services. For most people, this care generally is 
custodial, or nonskilled, for people who can't take care of themselves 
due to physical, emotional, or mental problems. Medicare does not pay 
for custodial care and does not pay for most nursing home care. 
For more information about nursing homes, see page 29. 

Some nursing homes may provide skilled care after an injury or hospital 
stay. Medicare pays for skilled nursing facility care for a limited period 
of time if you meet certain conditions. For more information, look at the 
Medicare booklet, Medicare Coverage of Skilled Nursing Facility Care 
(CMS Pub. No. 10153). See pages 37-38 to find out how to get a copy. 

The cost for nursing homes can vary depending on where you live and 
what type of care you need. In 2001, the national average cost for a 



15 



nursing home is $160 per day, or $50,000 to $60,000 per year. The cost 
of nursing home care usually increases by 5 to 10 percent per year. 

Summary of Long-Term Care Choices 

As you can see, the cost of long-term care can vary quite a bit 
depending on what kind of care you need, where you get the care, and 
where you live. The chart below shows how these costs generally 
compare with each other. For more about how to pay for long-term care 
costs, see page 25. 





Help with 

activities 

of daily 

living 


Help with 

additional 

services 


Help with 
care needs 


Range of 
costs 


Community services 


Yes 


Yes 


No 


Low to 
medium 


Home care 


Yes 


Yes 


Yes 


Low to high 


Accessory dwelling 
units 


Yes 


Yes 


Yes 


Low to high 


Subsidized senior 
housing 


Yes 


No 


No 


Low to high 


Board and care home 


Yes 


Yes 


Yes 


Low to high 


Assisted living 


Yes 


Yes 


Yes 


Medium 
to high 


Continuing care 
retirement community 


Yes 


Yes 


Yes 


High 


Nursing home 


Yes 


Yes 


Yes 


High 



16 



Step 3. Find out what choices are available where you live. 

The number of long-term care choices you have can vary. In some 
areas, especially rural areas, there may be only one or two kinds of 
long-term care choices. Most areas, however, have more options. Here 
are some ways to learn what long-term care choices are available in 
your area: 

• Talk with your family and others you trust like your minister, rabbi, 
priest, or spiritual advisor about your personal and health care 
needs. Ask them to help you learn about long-term care choices 
and services where you live. 

• Talk with your doctor or someone in your doctor's office. Ask him 
or her what long-term care choices and services are available to 
help meet your needs, now and in the future. 

• Visit or call your local social service agency or hospital. Ask to 
speak to a social worker or care manager who can help you with 
locating and coordinating different kinds of long-term care choices 
and services. 

• Call your area Agency on Aging. This agency can give you 
information on all community services for older people that are 
available where you live. These services may include meal 
programs in the home and at senior centers, homemaker services, 
adult day care, transportation, subsidized senior housing, home 
repair, legal services, and others. You can get the telephone number 
of your local area Agency on Aging by looking on the 
Administration on Aging (AoA) Web site or by calling the 
Eldercare Locator. 

c=a www.aoa.gov 

(Select "About AoA and the Aging Network." Then select 
"Area Agencies on Aging.") 

^ 1-800-677-1 1 16 (Weekdays, 9:00 a.m. to 8:00 p.m. 
Eastern time) 



17 



• Go to the Medicare Web site. You can find detailed information on 
nursing homes and how to compare nursing homes in your town or 
State, some alternatives to nursing homes, the rights of nursing 
home residents, and other related information. If you do not have a 
computer, your local library or senior center may be able to help you 
find this information on their computers. 

c^s www.medicare.gov 

(Select "Nursing Homes.") 

Step 4. Find out how these programs and services rate in quality. 

Quality care means doing the right thing, at the right time, in the right 
way for the right person — and having the best possible results. The 
Medicare program certifies nursing homes and home health agencies to 
make sure they meet certain Federal health and safety requirements. But 
beyond this basic requirement, the quality of long-term care programs, 
services, and facilities may vary. 

Here are some ways to learn about how long-term care programs and 
services in your area rate in quality: 

• Ask friends and other people you know who use different kinds of 
long-term care services if they are satisfied with the services they get. 

• Call your local office of consumer affairs and ask if they have 
information on the quality of nursing homes, home care agencies, 
and other long-term care programs and services in your area. You 
can get the telephone number of your local office of consumer 
affairs by looking in the blue pages of your local telephone book. 

• Call your State health department. Ask if you can get information 
on the quality of nursing homes and other long-term care facilities 
and services in your area. You can get the telephone number of your 
State health department by looking in the blue pages of your local 
telephone book. 



18 



• Call your State or local Long-Term Care Ombudsman. Ombudsmen 
visit nursing homes and other long-term care facilities regularly to visit 
residents and take care of complaints. Your local area Ombudsman 
can also give you information on the most recent State inspection 
survey for long-term care facilities in your area. You can get the 
telephone number of your local area Ombudsman by looking on the 
Administration on Aging Web site or by calling the Eldercare Locator. 

ei www.aoa.gov 

(Select "About AoA and the Aging Network." Then select 
"LTC Ombudsman Programs.") 

S 6 1-800-677-1 116 (Weekdays, 9:00 a.m. to 8:00 p.m. 
Eastern time) 

• Look on the Medicare Web site for Nursing Home Compare. You 
can compare the State inspection records of nursing homes in your 
area and find other quality information. If you do not have a 
computer, your local library or senior center may be able to help you 
find this information on their computers. 

c=s www.medicare.gov 

(Select "Nursing Home Compare") 

Step 5. Visit the facilities or programs you are considering. 

Before you make a final decision about long-term care, call and ask for 
information about the program or facility. Visit the places you are 
interested in. These places can be assisted living communities, services 
in senior centers, housing programs, nursing homes, and other programs. 
Make an appointment to talk to the program coordinator or care 
supervisor before you visit. Here are some tips to help you get ready: 

• Talk with your doctor or other health care provider and with your 
family about what long-term care services you need now or may 
need in the future. 

• Go over any information you have already received. 



19 




• Write down any questions you still have about how the facility or 
program will meet your needs. 

When you visit, look around carefully. Ask questions about anything 
you do not understand. Talk to staff, residents, and family 
members if you can. Ask them if they are satisfied 
with the facility or program and its services. 

After your visit, ask yourself the following questions: 

• Did they listen to me and make me feel comfortable? Yes No 

• Did I get to ask all my questions? Yes No 

• Did they give me answers I understood? Yes No 

• Are the program staff respectful and helpful? Yes No 

• Does the facility or program meet the needs I have? Yes No 

• Do residents/participants appear 

clean and well groomed? Yes No 

• Does the facility offer activity programs that I enjoy? Yes No 

• Is the facility clean and pleasant? Yes No 

By now, if you have followed the steps above, you and your family may 
be ready to choose the kind of long-term care that is best for you. Not 
everyone needs the same kinds of services at the same time. Also, your 
health care and personal needs may change as you get older. You may 
need more services later than you do now. 

Long-term care can be very expensive. Because Medicare generally 
does not pay for long-term care, it is important to think ahead about 
how you will pay for the care you get. See page 25 for more 
information on paying the costs of long-term care. 



20 



Things To Remember 

• Long-term care can be provided at home, in the community, or in 
various facilities, like nursing homes and assisted living 
communities. 

• Long-term care can help people with usual activities of daily 
living like bathing and dressing, eating, and using the bathroom. 
It may also include care that most people do themselves, like using 
eye drops. 

• It is important to talk with your doctor or other health care 
provider and with your family or other trusted person about your 
long-term care needs. These needs may change over time. 

• The best time to think about long-term care is before you need it. 
Learn as much as you can about available long-term care choices 
and how they rate in quality. 

• The cost of long-term care can vary depending on the kind and 
amount of services you need. 

• Generally, Medicare does not pay for long-term care. 



21 



NOTES 



22 



Section 2 



If You Want 
To Know More 




23 



This section has detailed information on planning and paying for long- 
term care, including: 



How To Pay for Long-Term Care 




• More About Nursing Homes 



Health Care Advance Directives 



Where To Get More Information 



More Words You Should Know 



Accredited (accreditation). Having a "seal of approval." Being 
accredited means that a facility or health care organization has met 
certain quality standards. These standards are set by private, nationally 
recognized groups that check on the quality of care of health care 
facilities and organizations. 

Certified (certification). This means a long-term care facility has 
passed an inspection survey done by a State government agency. Being 
certified is not the same as being accredited. Only care in a certified 
facility or program is covered by Medicaid or Medicare. 

Licensed (licensure). This means a long-term care facility has met 
certain standards set by a State or local government agency. 

Long-term care insurance. A private insurance policy to help pay for 
some long-term medical and nonmedical care, like help with activities of 
daily living. Because Medicare generally does not pay for long-term care, 
this type of insurance policy may help provide coverage for long-term 
care that you may need in the future. Some long-term care insurance 
policies offer tax benefits; these are called "Tax-Qualified Policies." 

Respite care. Temporary or periodic care provided in a nursing home, 
assisted living residence, or other type of long-term care program so 
that the usual caregiver can rest or take some time off. 



24 





Paying for Long-Term Care 

*i> Health insurance plans and other programs, 

including Medicare, generally do not cover long- 
term care. Long-term care can be very expensive. 
:::: --- You might use your savings or a life insurance 
policy to pay for long-term care. Or you might decide to buy a long- 
term care insurance policy. Some important things to know about 
paying for long-term care costs are listed here. You can find more 
details on the Medicare Web site. 

ct www.medicare.gov/Nursing/Payment.asp 

• Medicare. IMPORTANT: Medicare does not pay for help with 
activities of daily living or other care that most people do 
themselves. Medicare will help pay only for medically necessary 
skilled nursing facility or home health care if you need skilled care 
for an illness or injury and you meet certain conditions. 

• Personal resources. You can use your savings to pay for long-term 
care. Some insurance companies let you use your life insurance 
policy to pay for long-term care. Ask your insurance agent how this 
works. 

Most people who enter nursing homes begin by paying for their care 
out of their own pocket. As they use up their resources over a 
period of time, they may eventually become eligible for Medicaid. 

• Medicaid. This is a State and Federal Government program that 
pays for certain health services and nursing home care for older 
people with low incomes and limited assets. In some States, 
Medicaid also pays for some long-term care services at home and in 
the community. Who is eligible and what services are covered vary 
from State to State. Most often, eligibility is based on your income 
and personal resources. Sometimes you must spend down your 
personal resources before you qualify. 



25 



To get more information on Medicaid eligibility requirements in 
your State, call your State Medical Assistance office. You can find 
the telephone number in the Medicare & You handbook (CMS Pub. 
No. 10050), by looking on the Medicare Web site, or by 
calling 1-800-MEDICARE. 

ei www.medicare.gov 

(Select "Helpful Contacts." Select the State you want; 
then select "Other Health Insurance Programs.") 

^ 1-800-MEDICARE (1-800-633-4227) 
(24 hours a day, 7 days a week) 



m 1-877-486-2048 (toll-free) 

• Programs of All-inclusive Care for the Elderly (PACE). PACE 

combines medical, social, and long-term care services for frail 
people. PACE is available only in States that have chosen to offer it 
under Medicaid. To be eligible, you must be at least age 55, live in 
the service area of a PACE program, and be certified as eligible for 
nursing home care by the appropriate State agency. Persons 
enrolled in a PACE program may have to pay a monthly premium. 

PACE provides a range of long-term care services, like help with 
personal care, health needs, meals, and transportation. The goal of 
PACE is to help people, who otherwise might have to live in a 
nursing home or other long-term care facility, remain in their 
homes while receiving the high-quality services they need. 

Services are provided by a team of health care professionals. These 
services are usually provided in a PACE center but may also include 
some home or referral services. Minimum services include health 
care services by doctors and nurses, some therapy, social services, 
personal care and support services, nutrition counseling, and meals. 

You can get more information about PACE from your State Medical 
Assistance office. The telephone number is in the Medicare & You 
handbook (CMS Pub. No. 10050). You can also find out if there is 
^ /J a PACE program in your area by looking on the Medicare Web site. 



co] www.medicare.gov/Nursing/Alternatives/Pace.asp 

• Long-term care insurance. This type of private insurance policy 
can help pay for many types of long-term care, including both 
skilled and nonskilled care. 

Long-term care insurance coverage can vary widely. Some policies 
may cover only nursing home care. Others may include coverage 
for a whole range of services like care in an adult day care center, 
assisted living, medical equipment, and informal home care. 

Long-term care insurance can be expensive, depending on your age 
and health status when you buy the policy and how much coverage 
you want. It is better to buy long-term care insurance at a younger 
age when premiums are lower. But you can buy long-term care 
insurance at any age. Talk about this with a family member or 
financial advisor to learn what is best for you. 

The cost of care, especially in nursing homes and assisted living 
facilities, varies from State to State. Make sure that the policy you 
buy will cover the costs of care where you plan to use it. 

Most long-term care insurance policies offer certain tax benefits. 
These policies are called "Tax-Qualified," or "TQ," policies. 
Depending on your age, you can include some or all of the 
premium for a "TQ" policy as a medical deduction on your Federal 
income tax form if you itemize your deductions. Also, when you 
receive payments from a "Tax-Qualified" policy, you do not have to 
pay Federal tax on them. 

Private insurance companies sell long-term care insurance policies. 
You can buy them from an insurance agent or through the mail. Or 
you may be able to buy a group policy through an employer or 
through membership in an association. 

Buying a long-term care policy is an important decision. Make 
sure that you buy from a reliable company. Insurance companies 
must be licensed by your State to sell long-term care insurance. 



27 



Be certain that you are dealing with a company that you know. If 
you decide to buy long-term care insurance, be sure that the 
company and the agent, if one is involved, is licensed in your State. 
If you are not sure, call your State insurance department. 

If you are considering buying long-term care insurance, call the 
insurance company and ask for a sample policy or Outline of 
Coverage that shows benefits and costs. Go over the information 
carefully. Compare the costs and benefits of policies from different 
insurance companies. Find out if any of the policies are "Tax- 
Qualified" if this is important to you. Be sure to talk with the 
insurance agent about anything you do not understand. 

By fall 2002, there will be a chance for Federal employees, 
members of the Uniformed Services, retirees, their spouses, and 
other qualified relatives to buy long-term care insurance at 
discounted group rates. Under the new Federal Long-Term Care 
Insurance Program, insurers that are selected and approved by the 
Government will make long-term care insurance available to those 
individuals who qualify. More details will be available in early 
2002. You can find more information by looking on the Web. 

si www.opm.gov/insure/ltc 

If you have questions about where to buy long-term care insurance 
in your area, call your State insurance department. You can find the 
telephone number for your State in the Medicare & You handbook 
(CMS Pub. No. 10050), by looking on the Medicare Web site, or by 
calling 1-800-MEDICARE. 

c=d www.medicare.gov 

(Select "Helpful Contacts." Select the State you want; 
then select "General Medicare Information.") 

T? 1-800-MEDICARE (1-800-633-4227) 
(24 hours a day, 7 days a week) 



28 



1-877-486-2048 (toll-free) 




A Few Words About Nursing Homes 

For some people who cannot live on their own, a nursing home may be 
the best long-term care choice. Nursing homes can vary greatly in what 
services they offer and how they care for their residents. This is why it is 
important to visit any facility you may be thinking about using to make 
sure that it can meet your needs, as well as those of your family. A few 
things to consider when choosing a nursing home are listed here. 
You may think of other questions; if so, write them at 
the bottom of the list. 



Is the nursing home accepting new residents? Yes No. 

Is the nursing home easy to visit for family 
and friends? 

Does the nursing home use hospitals 
where my doctor practices? 

Does the nursing home have the services I need? 

Does the nursing home have a variety of activities 
I might enjoy? 

Do residents appear clean and well groomed? 

Is the nursing home clean and pleasant? 

Is the nursing home certified by Medicare and Medicaid? Yes No. 

Are the nursing home and current administrator licensed? Yes No_ 

Other questions I think are important: 



Yes 


No 


Yes 


No 


Yes 


No 


Yes 


No 


Yes 


No 


Yes 


No 


Yes 


No 


Yes 


No 



29 



It may also be helpful to find out if the facility you are considering is 
accredited by the Joint Commission on the Accreditation of Healthcare 
Organizations (JCAHO). Being accredited is like having a "seal of 
approval." It means the nursing home meets certain standards for care 
that JCAHO sets. You can find information on accreditation of nursing 
homes in your area on the JCAHO Web site. 

cfa www.jcaho.org 

(Select "Quality Check.") 

Care in a nursing home can be very expensive. This is because it covers 
24-hour medical care as well as room, meals, activities, and some 
personal care. Most nursing homes charge a basic fee for room, meals, 
and some personal care. You may have to pay extra for other services or 
care for special medical needs. It is important to get a list of fees in 
advance and discuss these costs and how you will pay for them. 

Some nursing homes may also provide respite care. Medicare, private 
insurance, or Medicaid may pay for respite care if you are getting covered 
hospice care (special care for the terminally ill). 

The Medicare Web site has a detailed checklist with tips on what to look 
for in a nursing home. Some of these tips include learning about the kinds 
of services offered, levels of staff training and experience, safety and 
quality of life of the residents, and your rights and protections in a nursing 
home. You can also get a copy of this checklist by calling 
1-800-MEDICARE and asking for Your Guide to Choosing a Nursing 
Home (CMS Pub. No. 02174). Besides the checklist, this booklet has 
information on the rights of nursing home residents and other sources of 
information on choosing a nursing home. 



www.medicare.gov/Nursing/Checklist.asp 

1-800-MEDICARE (1-800-633-4227) 
(24 hours a day, 7 days a week) 



30 




H 1-877-486-2048 (toll-free) 



A Few Words About Health Care Advance Directives 

While planning for long-term care, you may want to talk with your 
doctor about health care advance directives. It's a way for you and your 
doctor to talk about the type of treatments you want or don't want in case 
you cannot speak for yourself. A health care advance directive is a 
written document that says how you want medical decisions to be made if 
you lose the ability to make decisions for yourself. The two most 
commonly prepared health care advance directives are: 

• A Living Will 

• A Durable Power of Attorney for Health Care 

A Living Will is a legal document written ahead of time that says what type 
of treatments you want or don't want in case you cannot speak for yourself. 
This document typically only comes into effect if you're terminally ill 
(usually if you have 6 months or less to live) or permanently unconscious 
and cannot speak for yourself. A Living Will doesn't let you name someone 
to make health care decisions for you. 

A Durable Power of Attorney for Health Care is a legal document that 
names someone else to make health care decisions for you if you become 
unable to make your own decisions. 

If you need help preparing a health care advance directive or need more 
information, you may want to talk to a lawyer, a nearby hospital, a 
hospice, or a long-term care facility. You can call your local office on 
aging to find out if your State has any legal services that can help you. 
You can get the telephone number of your area Agency on Aging by 
looking on the Administration on Aging Web site or by calling the 
Eldercare Locator. 



□ 



www.aoa.gov 

(Select "About AoA and the Aging Network." Then select 

"Area Agencies on Aging.") 



^ 1-800-677-1 1 16 (Weekdays, 9:00 a.m. to 8:00 p.m. 
Eastern time) 



31 




32 



Getting More Information 

More information is available to help you make the long-term care 
choice that meets your needs. Some free booklets can be ordered, and 
some information is on the Web. If you do not have a computer, your 
local library or senior center may be able to help you find the 
information on their computers. 

State Directories and Other Long-Term Care Information 

Some States publish reports on home and community-based services, 
nursing homes, and other long-term care choices and assistance 
programs for older people. The information can range from directories 
of long-term care programs in the State to manuals of "best practices" 
in how nursing homes solve common problems. A few examples of the 
kinds of information that States make available are listed here. Your 
local library or senior center may be able to tell you if this kind of 
information is available for your State. 

• Colorado. The Health Facilities Division of the Colorado 
Department of Public Health and Environment publishes separate 
"best practice" manuals for nursing homes and assisted living 
facilities. To learn more: 

a www.hfd.cdphe.state.co.us/static/ncfbp.htm 

• Michigan. The Michigan Office of Services to the Aging publishes 
consumer pamphlets and other information on the complete range 
of long-term care services and programs for older people. To learn 
more: 

en www.miseniors.net 

(Select "Search for Services.") 

• New Jersey. The Division of Long Term Care Systems in the 
Department of Health and Senior Services publishes information on 
how to select the best long-term care setting and pay for care. To 
learn more: 



rai www.state.nj.us/health/ltc 

• New York. The New York State Department of Health presents 
information for consumers on assisted living facilities and choosing 
a nursing home. To learn more: 

cb www.health.state.ny.us/nysdoh/consumer/longterm.htm 

• North Carolina. The North Carolina Division of Aging publishes 
extensive information on home and community-based services, 
housing, and long-term care living arrangements in the State, 
including continuing care retirement communities, nursing homes, 
and assisted living facilities. To learn more: 

csa www.dhhs.state.nc.us/aging 

AAHSA Consumer Tips 

The American Association of Homes and Services for the Aging 
(AAHSA) offers a series of free "Consumer Tips" on finding home and 
community services, assisted living facilities, nursing homes, and 
continuing care retirement communities. You can also use the AAHSA 
Web site to find a range of long-term care housing and services for 
older people by State or ZIP Code. 

c=n www.aahsa.org 

(Select "Consumers.") 

AARP Consumer Resources 

The American Association of Retired Persons (AARP) has brochures 
and other information on long-term care and housing options for older 
people. Some are listed below. The AARP Web site lists other 
resources. Order by publication number. 

• Assisted Living: Weighing the Options (D 12466) 

• Before You Buy: A Guide to Long-Term Care Insurance (D 12893) 



33 



•A Caregiver Guide to Information and Resources (D 16697) 

• Choosing Good Care: A Family Guide to Finding a Nursing Home 
(D 17064) 

• Navigating Your Way to a Qualified Assisted Living Facility (D 17037) 

E3 American Association of Retired Persons 
611 E Street NW 
Washington, DC 20049 

si www.aarp.org 

^ 1-800-424-3410 

ALFA Online 

This service of the Assisted Living Federation of America (ALFA) 
provides an online directory of assisted living facilities and tips for 
consumers on what to look for when choosing a facility. 

c-n www.alfa.org 

(Select "Consumers.") 

AHCA Resources 

The American Health Care Association (AHCA) offers a variety of 
online resources to help consumers understand the different levels of 
long-term care, select the proper level of care, and learn what to look 
for in a long-term care insurance policy. You can call AHCA to request 
a free printed copy of A Consumer's Guide to Nursing Facilities or 
Understanding Long-Term Care Insurance. AHCA also has a Web 
site for consumers about long-term care. 

[S3 American Health Care Association 
1201 L Street NW 
Washington, DC 20005 

ess www.ahca.org 
34 (Select "Consumer Information.") 



ot www.longtermcareliving.com 
^ 1-800-628-8140 



NCAL Consumer Information 

The National Center for Assisted Living (NCAL), part of the American 
Health Care Association, offers information on the Web to help 
consumers learn about and select an assisted living residence. You can 
call to ask for a free printed copy of A Consumer Guide to Assisted 
Living and Residential Care Facilities or Understanding Long-Term 
Care Insurance. NCAL also has a Web site for consumers about long- 
term care. 

HEEH National Center for Assisted Living 
1201 L Street NW 
Washington, DC 20005 

en www.ncal.org 

(Select "Consumer Information.") 

cb www.longtermcareliving.com 

^ 1-800-628-8140 

Guide to Long-Term Care 

The Health Insurance Association of America (HIAA) offers several 
online and printed insurance guides for consumers, including the Guide 
to Long-Term Care. This guide gives tips on how to evaluate long-term 
care insurance. Visitors to the HIAA Web site can also find a directory 
of HIAA member companies offering long-term care policies. 

EZI Health Insurance Association of America 
1201 F Street NW, Suite 500 
Washington, DC 20004-1204 

cm www.hiaa.org 

(Select "Consumer Information.") ^ _ 



^ 202-824-1600 

Health Pages 

Health Pages is a Web site with articles for consumers on various topics 
related to health and long-term care, including how to choose a nursing 
home and what to look for in long-term care insurance. You can read or 
print these articles from your computer. 

• All About Home Health Services. 3 pages. 

• Choosing a Nursing Home. 7 pages. 

• Is Long-Term Care Insurance for You? 6 pages. 

col www.thehealthpages.com 
(Select "Seniors' Health.") 

Healthfinder 

The healthfinder Web site, run by the U.S. Department of Health and 
Human Services, offers reliable consumer information from the Federal 
Government and its many partners. It has links to Web sites with 
consumer health information, online publication catalogs, online 
brochures, and databases and search engines that help you find 
information on the Web. 

to www.healthfinder.gov 

How to Choose a Home Care Provider 

This guide is an online service of the National Association for Home 
Care, which distributes information about home care and hospice to 
consumers. It includes information on how to find a home care or 
hospice agency and how to pay for care. 

o www.nahc.org 

(Select "Consumers.") 



36 



Resource Directory for Older People 

This online directory is a cooperative effort of the Federal 
Administration on Aging and the National Institute on Aging. It has 
names, addresses, telephone and fax numbers, and (when available) Web 
addresses of organizations that serve older people. The directory 
includes State Agencies on Aging and State Long-Term Care 
Ombudsman programs. 

en www.aoa.gov/directory/default.htm 

A Shopper's Guide to Long-Term Care Insurance 

This guide can be purchased from the National Association of Insurance 
Commissioners. In many States, you can you can get a free copy from 
your State insurance department. 

HS3 National Association of Insurance Commissioners 
2300 McGee Street, Suite 800 
Kansas City, MO 64108-3600 

c=b www.naic.org 

(Select "Consumer Publications.") 

United Seniors Health Council 

The United Seniors Health Council (USHC) Web site provides tips on 
how to choose and pay for long-term care insurance. You can also find 
price information on USHC publications like Long-Term Care 
Planning: A Dollar & Sense Guide. 

SB www.unitedseniorshealth.org 

Medicare Information 

Many free booklets can be ordered from the Medicare Web site and by 
calling 1-800-MEDICARE. These booklets explain Medicare benefits, 
coverage, rights, health plan choices, and more. A few examples are 
listed below. 



37 



1 Your Guide to Choosing a Nursing Home. (CMS Pub. No. 02174) 

Nursing Homes. (CMS Pub. No. 10121) 

' Medicare Coverage of Skilled Nursing Facility Care. (CMS Pub. 
No. 10153) 

Medicare and Home Health Care. (CMS Pub. No. 10969) 

(3D www.medicare.gov 
(Select "Publications.") 

^ 1-800-MEDIC ARE (1-800-633-4227) 
(24 hours a day, 7 days a week) 



W 1-877-486-2048 (toll-free) 

The Medicare Web site provides access to several interactive databases, 
which offer detailed comparison information on nursing homes, 
Medicare health care plans, Medigap policies, and dialysis facilities by 
State or ZIP Code. You can also find information on programs that 
offer help in buying prescription drugs and a list of health care providers 
and suppliers in your area who accept Medicare. 

c=b www.medicare.gov 

(Select "Nursing Home Compare" for nursing homes, 
"Medicare Health Plan Compare" and "Medicare Personal 
Plan Finder" for health plans, "Medigap Compare" for 
Medigap policies, "Dialysis Facility Compare" for dialysis 
facilities, "Prescription Drug Assistance Programs" for drug 
assistance programs for individuals in need, "Participating 
Physician Directory" for Medicare participating physicians, 
and "Participating Supplier Directory" for Medicare 
participating suppliers.) 



38 



NOTES 






; 



39 



CHS LIBRARY 



U.S. Department of 

Health and Human Services 

Centers for Medicare & Medicaid Services 
(Formerly the Health Care Financing Administration) 
7500 Security Boulevard 
Baltimore, Maryland 21244-1850 

Official Business 

Penalty for Private Use $300 

Publication No. CMS-02223 
November 2001 




3 BD15 0D0113H3 7 



CENTERS for MEDICARE & MEDICAID SERVICES 





Agency for Healthcare Research and Quality 



This booklet, Choosing Long-Term Care, is one of 
a new series of booklets for people who are with 
Medicare. Other titles include Choosing a Doctor, 
Choosing Treatments, Choosing a Hospital, and 
Choosing a Medicare Health Plan. Each booklet 
can help you to make health care choices. Use this 
booklet to help you understand long-term care 
choices, who provides long-term care services, and 
how to pay for long-term care. 

To get a copy of this booklet in Braille or Spanish, 
call 1-800-633-4227, TTY/TDD: 1-877-486-2048 
for the hearing and speech impaired.